Severe Aortic Stenosis: 'Timely Treatment is Crucial for Survival'

Oct 31, 2017Posted By:
Boulder Community Health

It’s a troubling fact that, for some people, heart valve disease
progresses very slowly, so that the symptoms — such as fatigue,
shortness of breath, dizziness and palpitations — are barely noticeable.
Or, you can have no symptoms at all, even if the disease is severe. But
left untreated, some types of heart valve disease can have serious and
potentially fatal complications.

“About 25,000 people die from heart valve disease each year. For
those with severe aortic stenosis — the most dangerous type of valve
disease — the survival rate is low when left untreated. Survival
is only 50 percent at 2 years after the onset of symptoms and 20 percent
at 5 years without treatment,” interventional cardiologist
Srinivas Iyengar, MD, of Boulder Heart told a crowd of more than 115 people during a free health
lecture held on Oct. 11 in Boulder.

“Fortunately, there have been major advances in treating heart valve
disease,” he said.

Heart Valve Disease: A Problem of Faulty Heart Valves

The heart has four heart valves that control blood flow into and through
the heart. They are the aortic, mitral, pulmonic and tricuspid valves.

“Heart valve disease occurs when a valve becomes damaged, leading
to a backflow of blood or complete blockage of blood flow. Although problems
with heart valves are often linked to age-related factors, sometimes they
can develop from illnesses such as rheumatic fever or infective endocarditis,”
Dr. Iyengar said.

Two main problems can occur with these valves: regurgitation and stenosis.
Regurgitation occurs when a valve does not fully close and allows blood
to leak backwards. This is commonly referred to as a leaky valve. Stenosis
is the narrowing of a valve that prevents blood flow. It is often described
as a tightening valve.

Any of the four valves can have regurgitation or stenosis – sometimes
both – but the mitral and aortic valves are most likely to be damaged:

Mitral regurgitation is the most common type of heart valve disease. The valve becomes “leaky,”
allowing some blood to spill backwards into the lungs rather than going
forward into the heart’s left ventricle.

Mitral stenosis is a narrowing or tightening of the mitral valve opening that restricts
blood flow from the left atrium to the left ventricle.

Aortic regurgitation is a leakage that sometimes allows blood to flow backwards from the aorta
into the left ventricle. It can also be found in conjunction with aortic stenosis.

Aortic stenosis is a narrowing of the opening of the aortic valve that restricts blood
flow through the valve and eventually causes damage to the heart itself.

Aortic Stenosis: Untreated Patients Have a Poor Prognosis

Aortic stenosis, the most deadly heart valve disease, is more often seen
as an age-related issue that affects about 7 out of 100 people over the
age of 65 in the U.S., or about 1.5 million people.

“Many people who have aortic stenosis live without symptoms for many
years. Yet once they start to experience even minor symptoms, urgent treatment
is critical. The disease progresses rapidly, and when it becomes severe,
the prognosis is poor," Dr. Iyengar warned.

According to Dr. Iyengar, symptoms of aortic stenosis can include:
• Shortness of breath
• Dizziness or fainting
• Palpitations or a feeling of heavy, pounding or noticeable heartbeats
• Fatigue or reduced ability to do normal activities
• Chest pain, pressure or tightness

“Many people mistakenly attribute these symptoms to aging and don’t
get them checked out,” Dr. Iyengar said. “Yet timely intervention
is so important. A simple check with a stethoscope during a physical exam
can often identify the disease and save your life.”

TAVR: Newer, Less Invasive Treatment for Aortic Stenosis

Dr. Iyengar explained that medications can help manage the symptoms. However,
there are no medications that can reverse aortic stenosis. The only cure
is replacing the diseased valve.

Usually, heart valve replacement requires open-heart surgery. During this
procedure, patients are connected to a heart-lung bypass machine, which
does the work of the heart while their heart is stopped. The old valve
is removed and a new one is sutured in place. But open-heart surgery becomes
riskier with the older population or for patients not healthy enough to
undergo such an invasive procedure.

An alternative to this traditional surgery is a new, less invasive option
called Transcatheter Aortic Valve Replacement (TAVR). It involves replacing
the faulty valve via a catheter that’s threaded through a blood
vessel. TAVR has essentially become the standard of care for people with
severe aortic stenosis and whom open-heart surgery is considered too risky.

“With TAVR, your aortic valve is replaced with a new valve while
your heart is still beating. It does not require patients to be placed
on a heart-lung machine or have their chest opened up,” said Dr. Iyengar.

Results from multiple studies have shown better results in high-risk patients
receiving TAVR as opposed to open heart surgery. Also, newer evidence
suggests it can sometimes be an option for extending the lives of intermediate-risk patients.

Structural Heart Clinic at Boulder Heart

All hospitals that perform TAVR are required to have a uniquely trained
Heart Team that includes a cardiothoracic surgeon and an interventional
cardiologist.

“BCH recently formed such a team at Boulder Heart. Only through collaboration
with a team can heart valve disease be identified and treated effectively.
The ultimate goal is better and more varied options for our patients and
our community,” Dr. Iyengar said.

To make an appointment with
Dr. Iyengar or if you have further questions about heart valve disease, contact Boulder
Heart’s Structural Heart Team at 303-442-2395.